Diabetic Neuropathy (Stoornis van de nerven bij diabetes)

Diabetic neuropathy is a type of neuropathy that arises as a complication of diabetes mellitus, primarily due to damage to the nervous system caused by prolonged high blood sugar levels. It often develops gradually, affecting nerves in the legs and feet first, before spreading to other parts of the body. The exact cause of diabetic neuropathy remains unclear, but it is believed to be related to several factors such as hyperglycemia, oxidative stress, inflammation, and autoimmune processes. Diabetic neuropathy affects approximately 50% of all people with diabetes and can significantly impact quality of life due to the associated symptoms.

Types of Diabetic Neuropathy

1. Peripheral diabetic neuropathy (perifereerde diabetische nerveusstoornis) - This is the most common form of diabetic neuropathy and typically affects the legs and feet. Symptoms may include numbness, pain, tingling sensations, muscle weakness, and decreased sensation to touch, heat, and cold.
2. Autonomic diabetic neuropathy (autonome diabetische nerveusstoornis) - This type of diabetic neuropathy affects the autonomic nervous system, controlling functions like heart rate, digestion, urination, and sexual function. Symptoms may include orthostatic hypotension, gastrointestinal problems, bladder dysfunction, and erectile dysfunction.
3. Sacral neuropathy (nerfziekten van het ruggenwervelbestanddeel sacrum) - Sacral neuropathy occurs when there is damage to the sacral nerves, which are responsible for sensation in the perineum and lower extremities. Symptoms may include urinary incontinence, fecal incontinence, and sexual dysfunction.
4. Mononeuropathies - These are specific conditions where one nerve becomes damaged or inflamed, such as carpal tunnel syndrome (median neuropathy), ulnar neuropathy at the elbow (ulnaris paralysis), or radiculopathy (damage to a spinal nerve root). Common symptoms include pain, numbness, and weakness in the affected area.
5. Arteritic ischemic optic neuropathy (aION) - A rare but serious complication of giant cell arteritis, aION affects the optic nerve and causes sudden vision loss. This condition requires immediate medical attention and treatment.

Diagnosis and Treatment

The diagnosis of diabetic neuropathy begins with a thorough physical examination and medical history assessment. Tests such as nerve conduction studies (NCS), electromyography (EMG), and blood tests may be ordered to confirm the diagnosis and determine the extent of nerve damage. The goal of treatment is to manage symptoms, slow or stop progression, and prevent complications.

1. Blood sugar control: Achieving optimal blood sugar control through diet, exercise, medications, or a combination of these measures can help reduce nerve damage and improve symptoms in people with diabetes-related neuropathies.
2. Pain management: Over-the-counter pain relievers like acetaminophen may be used for mild pain relief; stronger prescription medications such as gabapentin or pregabalin may be prescribed for more severe cases. Topical creams, transdermal patches, and even various devices like TENS units can also provide relief for some individuals.
3. Treatment of underlying conditions: For example, addressing vitamin B12 deficiencies or treating chronic kidney disease can help alleviate symptoms of neuropathy in certain cases.
4. Physical therapy: Regular exercise and physical therapy can help improve strength, balance, coordination, and overall mobility in those affected by diabetic neuropathy. Specialized therapies like occupational therapy or foot care education may also be beneficial for individuals with peripheral diabetic neuropathy in the feet.
5. Wound care: Individuals with diabetes-related neuropathy have an increased risk of developing foot ulcers due to reduced sensation. Proper foot care, including regular inspection and appropriate wound care techniques when necessary, can help prevent complications such as infection and amputation.
6. Surgery: In some cases, surgery may be necessary to address complications such as carpal tunnel syndrome or other mononeuropathies, or to treat painful nerve entrapments or compressions.
7. Alternative treatments: Some individuals may seek alternative treatments for diabetic neuropathy such as homeopathic remedies (thuymus divaricatus extracts), acupuncture, chiropractic care or massage therapy; however, these treatments should be discussed with healthcare providers before attempting them.
8. Lifestyle modifications: Quitting smoking, reducing alcohol intake, maintaining a healthy weight, and managing stress can all play a role in slowing down the progression of diabetic neuropathy and improving overall health outcomes for individuals with diabetes.